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face pain > chronic pain management > Flashcards

chronic pain management Flashcards

1
Q

ACUTE PAIN TRANSFORMATION

A
  • ACUTE PAIN CAN BECOME CHRONIC IF IT LASTS
    MORE THAN 6 MONTHS OR THE TIME IT WOULD
    TAKE CONNECTIVE TISSUE TO HEAL
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2
Q

TEMPOROMANDIBULAR DISORDERS
* MANY ARE?
* CHRONIC TMD PAIN SYNDROMES LAST MORE THAN?

A
  • MANY ARE MILD AND SELF-LIMITING
  • CHRONIC TMD PAIN SYNDROMES LAST MORE THAN 6 MONTHS
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3
Q

what psychiatric symptoms AND CHRONIC MUSCULOSKELETAL PAIN HAVE
A DIRECT CORRELATION?

A

DEPRESSIVE SYMPTOMS AND CHRONIC MUSCULOSKELETAL PAIN HAVE
A DIRECT CORRELATION

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4
Q

what psychiatric dx INCREASES THE PATIENT’S SELF REPORTING OF PAIN
ESPECIALLY SKELETAL MUSCLE PAIN

A

ANXIETY INCREASES THE PATIENT’S SELF REPORTING OF PAIN
ESPECIALLY SKELETAL MUSCLE PAIN

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5
Q

approach for tx TMD should be single or multimodal

A

MULTI-MODALITY APPROACH IS BEST FOR MANAGEMENT OF TEMPOROMANDIBULAR
DISORDERS
* MEDICATIONS
* SPLINT THERAPY
* PHYSICAL THERAPY
* ACCUPUNCTURE
* PSYCHOTHERAPY
* SURGERY

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6
Q

CHRONIC OVERLAPPING PAIN CONDITIONS (COPCS)
COMMON CO-EXISTING PAIN CONDITIONS:

A
  1. TMD
  2. FIBROMYALGIA
  3. HEADACHES (MIGRAINES, TENSION-TYPE, AND TAC’S)
  4. IRRITABLE BOWEL SYNDROME (IBS)
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7
Q

team for tx TMD?

A

TEAM APPROACH FOR CHRONIC PAIN HAS BEST TREATMENT OUTCOME

  • INVOLVE MULTI-SPECIALTIES SUCH AS:
  • OROFACIAL PAIN
  • PHYSICAL THERAPY
  • PAIN PSYCHOLOGIST
  • RHEUMATOLOGIST
  • NEUROLOGIST
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8
Q

DIAGNOSES WITH SIMILAR SYMPTOMS
CAUSE HEAD & FACIAL PAIN:

A

MIGRAINE HEADACHE
· TENSION HEADACHE
* TRIGEMINAL AUTONOMIC CEPHALGIAS (TAC’S)
· TEMPORAL ARTERITIS
· EAR INFECTION
· SINUS INFECTION OR TUMORS
· TOOTH INFECTION
· JAW JOINT SPRAIN
· NEURALGIA
· JAW JOINT DISK DISPLACEMENT *

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9
Q

DIAGNOSES WITH SIMILAR SYMPTOMS
CAN CAUSE MALOCCLUSION:

A
  • ORAL CANCER
    · JAW JOINT TUMORS (I.E. OSTEOCHONDROMA)
    · DENTAL MALOCCLUSION ESPECIALLY SECONDARY TO OSTEOARTHRITIS OR RHEUMATOID ARTHRITIS
  • FACIAL MUSCLE SPASM
    JAW FRACTURE
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10
Q

pain tx flowchart: mild and moderate vs severe

A
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11
Q

ACETAMINOPHEN
* other names
* NO effect?
* bleeding?
* OVERDOSE:
* MAX DAILY DOSE:
* CHRONIC PAIN

A

ACETAMINOPHEN
* PARACETAMOL (GENERIC IN SOME FOREIGN COUNTRIES)
* APAP (ACETYL-PARA-AMINOPHENOL)
* NO ANTI-INFLAMMATORY EFFECTS
* MINIMAL INCREASED RISK OF BLEEDING
* OVERDOSE: HEPATOTOXICITY
* MAX DAILY DOSE: 4000 MG PER DAY IN DIVIDED DOSES EXCEPT
* CHRONIC PAIN -3000 MG PER DAY IN DIVIDED DOSES 11

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12
Q

ACETAMINOPHEN dose forms

A
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13
Q

acetaminophen combined with opioids

A

HYDROCODONE-ACETAMINOPHEN
* NORCO 5MG, 7.5MG, 10MG/325MG
* VICODIN 5MG, 7.5MG, 10MG/300MG

OXYCODONE WITH ACETAMINOPHEN
* ENDOCET, ROXICET: 5MG, 7.5MG, 10MG/ 325MG
* PERCOCET: 5MG, 7.5MG, 10MG/ 325MG

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14
Q

warning when using acetaminophen combined with opioids

A

WATCH FOR CONCURRENT MEDICATIONS CONTAINING ACETAMINOPHEN
ESPECIALLY OTC PRODUCTS SUCH AS SLEEP AIDS

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15
Q

acetaminophen COMBINATION WITH CODEINE

A

codiene increases by 2

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16
Q

acetaminophin with tramadol

A

ULTRACET
* ACETAMINOPHEN/TRAMADOL
* 320MG/37.5MG

17
Q

Advantages of Long-acting Opioids

A
  • MORE CONSISTENT ANALGESIA
  • FEWER ADVERSE EFFECTS
  • MORE TOLERANCE TO ADVERSE EFFECTS
  • BETTER SLEEP ➔ BETTER DAYTIME FUNCTION
  • LESS EUPHORIA, ADDICTION, DIVERSION
18
Q

OTC PRODUCTS CONTAINING ACETAMINOPHEN

A

Excedrin Extra strength, Excedrin Migraine
Acetaminophen/ Aspirin/ Caffeine
* 250mg/ 250mg/65mg

Comtrex
Acetaminophen/Dextromethorphan/ Phenylephrine
* 325mg/ 10mg/ 5mg

19
Q

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS) of interest

A
  • ASPIRIN
  • IBUPROFEN
  • NAPROXEN
  • MELOXICAM
  • CELECOXIB
20
Q

NSAIDS effects

A
  1. ANTI-INFLAMMATORY EFFECTS
  2. ANALGESIC EFFECTS
  3. ANTIPYRETIC EFFECTS
21
Q

nsaids effects at low doses

A
  • Antipyretic effects
  • Analgesic effects
22
Q

nsaids effects at high doses

A
  • Antipyretic effects
  • Analgesic effects
  • More anti-inflammatory effects besides mentioned effects
23
Q
  • IBUPROFEN (MOTRIN®, ADVIL®)
  • OTC dose?
  • RX doses?
  • MAX DOSE:
  • TOXICITY:
A
  • OTC 200MG
  • RX 400MG, 600MG, 800MG
  • MAX DOSE: 3200 MG PER DAY IN DIVIDED DOSES
  • TOXICITY: GI ULCER
24
Q

TO REACH ANTI-INFLAMMATORY EFFECTS of nsaids MUST USE how much?

A

TO REACH ANTI-INFLAMMATORY EFFECTS MUST USE 1800MG- 3200MG/DAY IN DIVIDED DOSES

25
Q

IBU with opioids

A

Oxycodone/ Ibuprofen
* 5mg/ 400mg
* Maximum of 4 tablets/day in divided doses

Hydrocodone/ Ibuprofen
* 2.5mg, 5mg, 7.5mg, 10mg/ 200mg
* Maximum of 5 tablets /day in divided doses

26
Q

long lasting nsaids

A

naproxen and celecoxib

27
Q

NAPROXEN (ALEVE® 220MG OTC)
* MAX DAILY DOSE:
* TOXICITY:
* COMBINATION WITH PPI ?

A
  • MAX DAILY DOSE: 1500 MG PER DAY IN DIVIDED
    DOSES
  • TOXICITY: GI ULCER
  • COMBINATION WITH PPI ESOMEPRAZOLE TO
    MINIMIZE THE GI DAMAGE (BRAND NAME VIMOVO®)
28
Q

CELECOXIB (CELEBREX®)
* moa
* dose
* AVOID IF PATIENT HAS?

A
  • SELECTIVE COX 2 INHIBITOR
  • 100MG OR 200 MG TWICE DAILY
  • AVOID IF PATIENT HAS SULFA ALLERGY
29
Q

ACETAMINOPHEN,
NSAIDS ceiling effect

A

These analgesics have ceiling effect
* Has a limit in relieving the pain
* Above the limit
* No more analgesic effect
* More toxicity

30
Q

ACETAMINOPHEN,
NSAIDS tolerence and dependence

A

No tolerance or dependence happen with
these analgesics

31
Q

how to lower GI ADRs of nsaids

A

Take NSAIDs with food to lower GI ADRs

face pain (12 decks)

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